Long‐term outcomes of cancer‐related isolated distal deep vein thrombosis: the OPTIMEV study

• Published in: Journal of thrombosis and haemostasis 2017-05, Vol.15 (5), p.907-916
• Main Authors: Galanaud, J.‐P., Sevestre, M.‐A., Pernod, G., Genty, C., Richelet, S., Kahn, S. R., Boulon, C., Terrisse, H., Quéré, I., Bosson, J.‐L.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Bleeding; Cancer; Death; deep vein thrombosis; Embolism; Epidemiological studies; Female; France - epidemiology; Hemorrhage - epidemiology; Humans; Incidence; Kaplan-Meier Estimate; Male; Middle Aged; Neoplasms - blood; Neoplasms - diagnosis; Neoplasms - epidemiology; Neoplasms - mortality; Popliteal Vein; Prognosis; Proportional Hazards Models; Prospective Studies; Recurrence; Risk Assessment; Risk Factors; Thromboembolism; Thrombosis; Time Factors; Veins & arteries; Venous Thromboembolism - blood; Venous Thromboembolism - diagnosis; Venous Thromboembolism - epidemiology; Venous Thromboembolism - mortality; Venous Thrombosis - blood; Venous Thrombosis - diagnosis; Venous Thrombosis - epidemiology; Venous Thrombosis - mortality
• ISSN: 1538-7933; 1538-7836; 1538-7836
• DOI: 10.1111/jth.13664

Essentials Clinical significance of cancer‐related isolated distal deep vein thrombosis (iDDVT) is unknown. We studied patients with iDDVT, with and without cancer, and proximal DVT with cancer. Cancer‐related iDDVT patients have a much poorer prognosis than iDDVT patients without cancer. Cancer‐related iDDVT patients have a similar prognosis to cancer‐related proximal DVT patients. Summary Background Isolated distal deep vein thrombosis (iDDVT) (infra‐popliteal DVT without pulmonary embolism [PE]) is a frequent event and, in the absence of cancer, is usually considered to be a minor form of venous thromboembolism (VTE). However, the clinical significance of cancer‐related iDDVT is unknown. Methods Using data from the observational, prospective multicenter OPTIMEV cohort, we compared, at 3 years, the incidences of death, VTE recurrence and major bleeding in patients with cancer‐related iDDVT with those in cancer patients with isolated proximal DVT (matched 1:1 on age and sex) and patients with iDDVT without cancer (matched 1:2 on age and sex). Results As compared with patients with cancer‐related isolated proximal DVT (n = 92), those with cancer‐related iDDVT (n = 92) had a similar risk of death (40.8% per patient‐year (PY) vs. 38.3% per PY; aHR = 1.0, 95% CI[0.7–1.4]) and of major bleeding (3.8% per PY vs. 3.6% per PY, aCHR = 0.9 [0.3–3.2]) and a higher risk of VTE recurrence (5.4% per PY vs. 11.5% per PY; aCHR = 1.8 [0.7–4.5]). As compared with patients with iDDVT without cancer (n = 184), those with cancer‐related iDDVT had a nine times higher risk of death (3.5% per PY vs. 38.3% per PY; aHR = 9.3 [5.5–15.9]), a higher risk of major bleeding (1.8% per PY vs. 3.6% per PY; aCHR = 2.0 [0.6–6.1]) and a higher risk of VTE recurrence (5.0% per PY vs. 11.5% per PY; aCHR = 2.0 [1.0–3.7]). The results remained similar in the subgroup of patients without history of VTE. Conclusion Patients with cancer‐related iDDVT seem to have a prognosis that is similar to that of patients with cancer‐related isolated proximal DVT and a dramatically poorer prognosis than patients with iDDVT without cancer. This underlines the high clinical significance of cancer‐related iDDVT and the need for additional studies.